A Place for Me Counseling Internship Interest Form
Fill the form below accurately indicating your suitability for the role you're interested in.
Name:
*
First Name
Last Name
E-mail Address:
*
example@example.com
Phone Number:
*
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What role are you interested in?
*
Practicum
Internship
Other
How many years experience do you have?
What is your level of experience in the listed areas of advice?
None
Min. experience
Experienced
Very experienced
Assessment
Counseling
Program Development
Mental Health
Treatment Planning
What other experiences do you have?
None
Min. experience
Experienced
Very experienced
Practice Management Software
Social Media
Content Creation
Marketing
Product Development
Microsoft
Other
What populations have you worked with? (List more recent first)
How many hours per week are you available?
What is the name of your school and program?
Job Skills & Training
Describe your skills:
Qualifications acquired:
Skills and qualifications desired:
Upload Resume:
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Cancel
of
Attachments
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of
LinkedIn URL
Submit Application
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